The Future of Municipal Wastewater Reuse Concentrate Management: Drivers, Challenges, and Opportunities.

Water reuse is rapidly becoming an integral feature of resilient water systems, where municipal wastewater undergoes advanced treatment, typically involving a sequence of ultrafiltration (UF), reverse osmosis (RO), and an advanced oxidation process (AOP). When RO is used, a concentrated waste stream is produced that is elevated in not only total dissolved solids but also metals, nutrients, and micropollutants that have passed through conventional wastewater treatment. Management of this RO concentrate─dubbed municipal wastewater reuse concentrate (MWRC)─will be critical to address, especially as water reuse practices become more widespread. Building on existing brine management practices, this review explores MWRC management options by identifying infrastructural needs and opportunities for multi-beneficial disposal. To safeguard environmental systems from the potential hazards of MWRC, disposal, monitoring, and regulatory techniques are discussed to promote the safety and affordability of implementing MWRC management. Furthermore, opportunities for resource recovery and valorization are differentiated, while economic techniques to revamp cost-benefit analysis for MWRC management are examined. The goal of this critical review is to create a common foundation for researchers, practitioners, and regulators by providing an interdisciplinary set of tools and frameworks to address the impending challenges and emerging opportunities of MWRC management.

Bromine and Chlorine Disinfection of Cryptosporidium parvum Oocysts, Bacillus atrophaeus Spores, and MS2 Coliphage in Water.

Conventional water treatment practices utilizing chemical disinfection, especially chlorination, are considered generally effective in producing microbiologically safe drinking water. However, protozoan pathogens such as oocysts of Cryptosporidium parvum are very resistant to chlorine, which has led to consideration of alternative disinfectants for their control. Free bromine, HOBr, has not been evaluated extensively as an alternative halogen disinfectant for inactivation of Cryptosporidium parvum in drinking water or reclaimed water for non-potable uses. Bromine is a versatile disinfectant consisting of different chemical forms with persistent microbicidal efficacy under varied water quality conditions and is effective against a range of waterborne microbes of health concern. The objectives of this study are to (1) compare the efficacy of free bromine to free chlorine at similar concentrations (as milligrams per liter) for disinfection of Cryptosporidium parvum oocysts, Bacillus atrophaeus spores, and MS2 coliphage in a model buffered water and (2) evaluate the kinetics of inactivation of these microorganisms using appropriate disinfection models. Overall, at a target concentration of ∼5 mg/L, bromine averaged 0.6 log (73.8%) reductions of C. parvum oocyst infectivity after 300 min (CT: 1166 min·mg/L) and produced up to a 0.8 log reduction disinfectant activity. An ∼5.0 mg/L chlorine dose increased oocyst infectivity by only 0.4 log (64%) after 300 min (CT: 895 min·mg/L). Bacillus atrophaeus spores and MS2 coliphage treated with bromine and chlorine were reduced by 4 log10 (99.99%) for both disinfectants over the duration of the experiments.

Evaluation of Chitosans as Coagulants-Flocculants to Improve Sand Filtration for Drinking Water Treatment.

The World Health Organization (WHO) reports that two billion people worldwide lack access to safely managed water sources, including 1.2 billion who already have access to improved water sources. In many countries, household point-of-use (POU) water-treatment options are used to remove or deactivate microorganisms in water, but not all POU technologies meet WHO performance requirements to achieve safe drinking water. To improve the effectiveness of POU technologies, the use of multiple treatment barriers should be used as a way to increase overall treatment performance. The focus of this research is to evaluate multiple barrier treatment using chitosan, an organic coagulant−flocculant, to improve microbial and turbidity reductions in combination with sand filtration. Bench-scale intermittently operated sand filters with 16 cm layers of sands of two different grain sizes representing slow and rapid sand filters were dosed daily over 57 days with microbially spiked surface water volumes corresponding to household use. E. coli bacteria and MS2 coliphage virus reductions were quantified biweekly (N = 17) using culture methods. Bacteria and virus removals were significantly improved over sand filtration without chitosan pretreatment (Wilcoxon Rank-Sum, p < 0.05). When water was pretreated at an optimal chitosan dose of 10 mg/L followed by sand filtration, log10 reductions in bacteria and viruses met the two-star WHO performance level of effectiveness. Microbial and turbidity reductions generally improved over the filter operating period but showed no trends with filtration rates.

Persistence of Coronavirus Surrogates on Meat and Fish Products during Long-Term Storage.

Multiple pathways of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission have been examined, and the role of contaminated foods as a source of SARS-CoV-2 exposure has been suggested. As many cases of SARS-CoV-2 have been linked to meat processing plants, it may be that conditions in live animal markets and slaughterhouses or meat processing plant procedures transfer viral particles to meat, poultry, and seafood during animal slaughter, processing, storage, or transport. Because of the potential for contamination of foods such as beef, chicken, pork, or fish, the goal of this study was to evaluate the survival of a lipid enveloped RNA bacteriophage, phi 6, as well as two animal coronaviruses, murine hepatitis virus (MHV) and transmissible gastroenteritis virus (TGEV), as SARS-CoV-2 surrogates for their survival under various meat and fish cold-storage conditions over 30 days. Viral surrogates differed in survival, depending on food product and temperature, but overall, viruses survived for extended periods of time at high concentrations at both refrigerated and frozen temperatures. The ability of SARS-CoV-2 viral surrogates like Phi 6 and animal coronaviruses to survive for varying extents on some meat and fish products when stored refrigerated or frozen is a significant and concerning finding. Continued efforts are needed to prevent contamination of foods and food processing surfaces, worker hands, and food processing utensils such as knives, and there is a need to better address the lack of or inadequate disinfection of these foods prior to meat packaging. IMPORTANCE The ability of SARS-CoV-2 viral surrogates like Phi 6 and animal coronaviruses to survive for long periods on meat and fish products at cold temperatures emphasizes the need for rigorous and sustained food sanitation and hygiene in the harvest, transport, processing, and distribution of these foods.

Absence of virological and epidemiological evidence that SARS-CoV-2 poses COVID-19 risks from environmental fecal waste, wastewater and water exposures.

This review considers evidence for infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presence and COVID-19 infection and illness resulting from exposure to environmental fecal wastes and waters. There is no documented evidence that (1) infectious, replication-capable SARS-CoV-2 is present in environmental fecal wastes, wastewater or water, and (2) well-documented epidemiological evidence of COVID-19 infection, illness or death has never been reported for these exposure media. COVID-19 is transmitted mainly by direct personal contact and respiratory secretions as airborne droplets and aerosols, and less so by respiratory-secreted fomites via contact (touch) exposures. While SARS-CoV-2 often infects the gastrointestinal tract of infected people, its presence as infectious, replication-capable virus in environmental fecal wastes and waters has never been documented. There is only rare and unquantified evidence of infectious, replication-capable SARS-CoV-2 in recently shed feces of COVID-19 hospital patients. The human infectivity dose-response relationship of SARS-CoV-2 is unknown, thereby making it impossible to estimate evidence-based quantitative health effects assessments by quantitative microbial risk assessment methods requiring both known exposure assessment and health effects assessment data. The World Health Organization, Water Environment Federation, US Centers for Disease Control and Prevention and others do not consider environmental fecal wastes and waters as sources of exposure to infectious SARS-CoV-2 causing COVID-19 infection and illness.

UV Inactivation of SARS-CoV-2 across the UVC Spectrum: KrCl* Excimer, Mercury-Vapor, and Light-Emitting-Diode (LED) Sources.

Effective disinfection technology to combat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can help reduce viral transmission during the ongoing COVID-19 global pandemic and in the future. UV devices emitting UVC irradiation (200 to 280 nm) have proven to be effective for virus disinfection, but limited information is available for SARS-CoV-2 due to the safety requirements of testing, which is limited to biosafety level 3 (BSL3) laboratories. In this study, inactivation of SARS-CoV-2 in thin-film buffered aqueous solution (pH 7.4) was determined across UVC irradiation wavelengths of 222 to 282 nm from krypton chloride (KrCl*) excimers, a low-pressure mercury-vapor lamp, and two UVC light-emitting diodes. Our results show that all tested UVC devices can effectively inactivate SARS-CoV-2, among which the KrCl* excimer had the best disinfection performance (i.e., highest inactivation rate). The inactivation rate constants of SARS-CoV-2 across wavelengths are similar to those for murine hepatitis virus (MHV) from our previous investigation, suggesting that MHV can serve as a reliable surrogate of SARS-CoV-2 with a lower BSL requirement (BSL2) during UV disinfection tests. This study provides fundamental information on UVC's action on SARS-CoV-2 and guidance for achieving reliable disinfection performance with UVC devices. IMPORTANCE UV light is an effective tool to help stem the spread of respiratory viruses and protect public health in commercial, public, transportation, and health care settings. For effective use of UV, there is a need to determine the efficiency of different UV wavelengths in killing pathogens, specifically SARS-CoV-2, to support efforts to control the ongoing COVID-19 global pandemic and future coronavirus-caused respiratory virus pandemics. We found that SARS-CoV-2 can be inactivated effectively using a broad range of UVC wavelengths, and 222 nm provided the best disinfection performance. Interestingly, 222-nm irradiation has been found to be safe for human exposure up to thresholds that are beyond those effective for inactivating viruses. Therefore, applying UV light from KrCl* excimers in public spaces can effectively help reduce viral aerosol or surface-based transmissions.

Chitosan Coagulation Pretreatment to Enhance Ceramic Water Filtration for Household Water Treatment.

Viruses are major contributors to the annual 1.3 million deaths associated with the global burden of diarrheal disease morbidity and mortality. While household-level water treatment technologies reduce diarrheal illness, the majority of filtration technologies are ineffective in removing viruses due to their small size relative to filter pore size. In order to meet the WHO health-based tolerable risk target of 10-6 Disability Adjusted Life Years per person per year, a drinking water filter must achieve a 5 Log10 virus reduction. Ceramic pot water filters manufactured in developing countries typically achieve less than 1 Log10 virus reductions. In order to overcome the shortfall in virus removal efficiency in household water treatment filtration, we (1) evaluated the capacity of chitosan acetate and chitosan lactate, as a cationic coagulant pretreatment combined with ceramic water filtration to remove lab cultured and sewage derived viruses and bacteria in drinking waters, (2) optimized treatment conditions in waters of varying quality and (3) evaluated long-term continuous treatment over a 10-week experiment in surface waters. For each test condition, bacteria and virus concentrations were enumerated by culture methods for influent, controls, and treated effluent after chitosan pretreatment and ceramic water filtration. A > 5 Log10 reduction was achieved in treated effluent for E.coli, C. perfringens, sewage derived E. coli and total coliforms, MS2 coliphage, Qß coliphage, ΦX174 coliphage, and sewage derived F+ and somatic coliphages.

Turbidity reduction in drinking water by coagulation-flocculation with chitosan polymers.

Turbidity reduction by coagulation-flocculation in drinking water reduces microbes and organic matter, increasing effectiveness of downstream treatment. Chitosan is a promising household water coagulant, but needs parameters for use. This study tested the effects of chitosan dose, molecular weight (MW), degree of deacetylation (DD), and functional groups on bentonite and kaolinite turbidity reduction in model household drinking water. Higher MW or DD produced greater reductions. Highest reductions were at doses 1 and 3 mg/L by MW >50,000 or >70% DD (residual turbidity <5 NTU). Higher doses did not necessarily continually increase reduction. For functional groups, 3 mg/L produced the highest reductions by lactate, acetate, and HCl, and lower reductions of kaolinite than bentonite. Doses where the point of zero charge was observed clustered around 3 mg/L. Chitosan reduced clay turbidity in water; effectiveness was influenced by dose, clay type, MW, DD, and functional groups. Reduction did not necessarily increase with MW. Bentonite had a broader effective dose range and higher reduction at the optimal dose than kaolinite. Chitosans with and without functional groups performed similarly. The best of the studied doses was 3 mg/L. Chitosans are promising for turbidity reduction in low-resource settings if combined with sedimentation and/or filtration.

Rapid Detection of Escherichia coli in Water Using Sample Concentration and Optimized Enzymatic Hydrolysis of Chromogenic Substrates.

Methods for rapid detection of fecal indicator bacteria in water are important to ensure that water is safe for drinking, bathing, recreation, fishing and shellfish harvesting. In this study, we tested experimental conditions for bacterial hydrolysis of two promising enzymatic substrates, 5-Bromo-4-chloro-3-indolyl ß-D-glucuronide (X-Gluc) and Resorufin ß-D-glucuronide (REG), and optimized parameters such as temperature and pH to determine conditions for rapid reactions. We then innovated a membrane filter-based approach to facilitate more rapid enzyme-based detection of Escherichia coli in water based on the combination of an initial concentration step and optimized test conditions. For this approach, a water sample (10‒100 mL) is filtered through a 0.45-µm pore size filter with a diameter of 4 or 13 mm. After filtration, a newly designed rapid detection broth is added containing the enzymatic inducer Methyl-beta-D-Glucuronide sodium (MetGlu) and the substrate REG or X-Gluc. After a few (1‒7) hours of incubation at 35 °C, the filter shows pink color (for REG-containing broth) or green color (for X-Gluc containing broth) if E. coli is present. The study provides insights and approaches towards developing a simple, fast, and low-cost method to detect fecal indicator bacteria in water.

Disinfection of bacteriophage MS2 by copper in water.

Households that lack piped water supply are often forced to meet water needs by storing in the home, leaving water vulnerable to contamination by viruses. Storage in copper containers can potentially prevent this type of contamination, but the inactivation kinetics of viruses by copper need to be described to make appropriate storage recommendations. This work characterized inactivation kinetics of bacteriophage MS2 as a surrogate for enteric viruses by dissolved ionic copper in water. Reduction of MS2 increased with increasing doses of copper. At 0.3 mg/L, there was a 1.8-log10 reduction of MS2 within 6 h. At 1 and 3 mg/L, 2-2.5 log10 inactivation could be achieved between 6 and 24 h. Parameters for the Chick-Watson, Hom, and One Hit-Two Population models of inactivation were calculated and evaluated, all of which demonstrated strong goodness-of-fit and predictability at various contact times. Copper inactivates MS2 under controlled conditions at doses between 0.3 and 3 mg/L. Although requiring longer contact times than conventional disinfectants, it is a candidate for improving the safety of stored drinking water.

Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach.

OBJECTIVE: To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. METHODS: A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. FINDINGS: The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. CONCLUSION: The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.

Disinfection of Escherichia coli and Pseudomonas aeruginosa by copper in water.

When households lack access to continuous piped water, water storage in the home creates opportunities for contamination. Storage in copper vessels has been shown to reduce microbes, but inactivation kinetics of enteric bacteria in water by copper alone needs to be understood. This work characterized inactivation kinetics of Escherichia coli and Pseudomonas aeruginosa by dissolved ionic copper in water. Reductions of E. coli and P. aeruginosa increase with increasing dose. At 0.3 mg/L, there was a 2.5 log10 reduction of E. coli within 6 hours. At 1 and 3 mg/L, the detection limit was reached between 3 and 6 hours; maximum reduction measured was 8.5 log10. For P. aeruginosa, at 6 hours there was 1 log10 reduction at 0.3 mg/L, 3.0 log10 at 1 mg/L, and 3.6 log10 at 3 mg/L. There was no significant decline in copper concentration. Copper inactivates bacteria under controlled conditions at doses between 0.3 and 1 mg/L. E. coli was inactivated more rapidly than P. aeruginosa. Copper at 1 mg/L can achieve 99.9% inactivation of P. aeruginosa and 99.9999997% inactivation of E. coli over 6 hours, making it a candidate treatment for stored household water.

Human viruses and viral indicators in marine water at two recreational beaches in Southern California, USA.

Waterborne enteric viruses may pose disease risks to bather health but occurrence of these viruses has been difficult to characterize at recreational beaches. The aim of this study was to evaluate water for human virus occurrence at two Southern California recreational beaches with a history of beach closures. Human enteric viruses (adenovirus and norovirus) and viral indicators (F+ and somatic coliphages) were measured in water samples over a 4-month period from Avalon Beach, Catalina Island (n = 324) and Doheny Beach, Orange County (n = 112). Human viruses were concentrated from 40 L samples and detected by nested reverse transcriptase polymerase chain reaction (PCR). Detection frequencies at Doheny Beach were 25.5% (adenovirus) and 22.3% (norovirus), and at Avalon Beach were 9.3% (adenovirus) and 0.7% (norovirus). Positive associations between adenoviruses and fecal coliforms were observed at Doheny (p = 0.02) and Avalon (p = 0.01) Beaches. Human viruses were present at both beaches at higher frequencies than previously detected in the region, suggesting that the virus detection methods presented here may better measure potential health risks to bathers. These virus recovery, concentration, and molecular detection methods are advancing practices so that analysis of enteric viruses can become more effective and routine for recreational water quality monitoring.

Evaluation of Three Different Selective Media for Enumeration of Clostridium perfringens in Untreated and Treated Wastewater.

Current and emerging legislation in North Carolina and other regions calls for the enumeration of Clostridium perfringens as a surrogate indicator for protozoan parasites in various types of waters. Past studies that have evaluated selective media for the detection of this bacterium have provided limited, conflicting, and inconclusive results. In this study, membrane filtration was used to enumerate C. perfringens as culturable spores or total culturable cells in 19 samples of untreated and 25 samples of partially treated wastewaters on 3 candidate media, Tryptose Sulfite Cycloserine Agar (TSC), CP ChromoSelect Agar (CPCS), and membrane Clostridium perfringens Agar (m-CP) in parallel, and the results were compared. Presumptive isolates from each agar were further subjected to phenotypic confirmation tests for acid phosphatase production and stormy fermentation to further determine the performance of each agar. The CPCS agar was determined to have the highest enumerative capacity of total C. perfringens cells when compared to both TSC agar and m-CP agar (p-value < 0.05), but there was no significant difference in its ability to detect spores when compared to TSC agar (p-value > 0.05). The overall specificity of CPCS agar as determined by agreement of results from both confirmation tests was 0.81, while the specificity of TSC agar was only 0.28. Based on its performance, ease of preparation and use and consistency of colony characteristics, CPCS agar is recommended as the preferred medium for C. perfringens enumeration in wastewater.

Relative benefits of on-plot water supply over other 'improved' sources in rural Vietnam.

OBJECTIVE: Access to improved water sources is rapidly expanding in rural central Vietnam. We examined one NGO-led piped water supply programme to assess the drinking water quality and health impacts of piped water systems where access to 'improved' water sources is already good. METHODS: This longitudinal, prospective cohort study followed 300 households in seven project areas in Da Nang province, Vietnam: 224 households who paid for an on-plot piped water connection and 76 control households from the same areas relying primarily on 'improved' water sources outside the home. The 4-month study was intended to measure the impact of the NGO-led water programmes on households' drinking water quality and health and to evaluate system performance. RESULTS: We found that: (i) households connected to a piped water supply had consistently better drinking water quality than those relying on other sources, including 'improved' sources and (ii) connected households experienced less diarrhoea than households without a piped water connection (adjusted longitudinal prevalence ratio: 0.57 (95% CI 0.39-0.86, P = 0.006) and households using an 'improved' source not piped to the plot: (adjusted longitudinal prevalence ratio: 0.59 (95% CI 0.39-0.91, P = 0.018). CONCLUSIONS: Our results suggest that on-plot water service yields benefits over other sources that are considered 'improved' by the WHO/UNICEF Joint Monitoring Programme.

Assessment of E. coli partitioning behavior via both culture-based and qPCR methods.

Quantitative polymerase chain reaction (qPCR) offers a rapid, highly sensitive analytical alternative to the traditional culture-based techniques of microbial enumeration typically used in water quality monitoring. Before qPCR can be widely applied within surface water monitoring programs and stormwater assessment research, the relationships between microbial concentrations measured by qPCR and culture-based methods must be assessed across a range of water types. Previous studies investigating fecal indicator bacteria quantification using molecular and culture-based techniques have compared measures of total concentration, but have not examined particle-associated microorganisms, which may be more important from a transport perspective, particularly during the calibration of predictive water quality models for watershed management purposes. This study compared total, free-phase, and particle-associated Escherichia coli concentrations as determined by the Colilert defined substrate method and qPCR targeting the uidA gene in stream grab samples partitioned via a calibrated centrifugation technique. Free-phase concentrations detected through qPCR were significantly higher than those detected using Colilert although total concentrations were statistically equivalent, suggesting a source of analytical bias. Although a specimen processing complex was used to identify and correct for inhibition of the qPCR reaction, high particle concentrations may have resulted in underestimation of total cell counts, particularly at low concentrations. Regardless, qPCR-based techniques will likely have an important future role in stormwater assessment and management.

UV Inactivation of Common Pathogens and Surrogates Under 222 nm Irradiation from KrCl* Excimer Lamps.

Germicidal ultraviolet (UV) devices have been widely used for pathogen disinfection in water, air, and on food and surfaces. Emerging UV technologies, like the krypton chloride (KrCl*) excimer emitting at 222 nm, are rapidly gaining popularity due to their minimal adverse effects on skin and eyes compared with conventional UV lamps emitting at 254 nm, opening opportunities for UV disinfection in occupied public spaces. In this study, inactivation of seven bacteria and five viruses, including waterborne, foodborne and respiratory pathogens, was determined in a thin-film aqueous solution using a filtered KrCl* excimer emitting primarily at 222 nm. Our results show that the KrCl* excimer can effectively inactivate all tested bacteria and viruses, with most microorganisms achieving more than 4-log (99.99%) reduction with a UV dose of 10 mJ cm-2 . Compared with conventional UV lamps, the KrCl* excimer lamp exhibited better disinfection performance for viruses but was slightly less effective for bacteria. The relationships between UV sensitivities at 222 and 254 nm for bacteria and viruses were evaluated using regression analysis, resulting in factors that could be used to estimate the KrCl* excimer disinfection performance from well-documented UV kinetics using conventional 254 nm UV lamps. This study provides fundamental information for pathogen disinfection when employing KrCl* excimers.

Evaluation of antibiotic-resistant bacteria in home kitchens and bathrooms: Is there a link between home disinfectant use and antibiotic resistance?

OBJECTIVE: To determine the relationship between home disinfectant use and the prevalence of antibiotic resistance among environmental isolates of human pathogens. METHODS: Bacteria were cultured from 5 kitchen and 5 bathroom sites using quantitative methods. Antibiotic susceptibility was determined by standard methods. Home disinfectant use was assessed via a questionnaire. RESULTS: The overall total mean log10 counts (total CFU) for the kitchen and bathroom were 4.31 and 4.88, respectively. Gram-positive bacteria were more common in the bathroom (4.05) than in the kitchen (3.60), while Gram-negative bacilli were more common in the kitchen (4.23) than in the bathroom (3.86). The sink and bath drains were the most contaminated sites with 6.16-log10 of total CFU and 6.6-log10 in the kitchen and bathroom, respectively. Households reported cleaning frequency with a variety of commercial products. Most respondents used antibacterial products (eg, soaps, surface disinfectants) in the home. Antibiotic-resistant pathogens were infrequently isolated in the homes evaluated. CONCLUSIONS: Compared to pathogens causing community-acquired clinical infections in the ICARE study, pathogens isolated from households are less likely to demonstrate antibiotic resistance. In addition, no relationship between antibacterial use or frequency of cleaning or disinfection and antibiotic resistance was revealed.

Deep tubewell use is associated with increased household microbial contamination in rural Bangladesh: Results from a prospective cohort study among households in rural Bangladesh.

Deep tubewells are important sources of arsenic mitigation in rural Bangladesh. Compared to commonly available shallow tubewells, deep tubewells tap into deeper low-arsenic aquifers and greatly reduce exposure to arsenic in drinking-water. However, benefits from these more distant and expensive sources may be compromised by higher levels of microbial contamination at point-of-use (POU). This paper examines differences in microbial contamination levels at source and POU among households using deep tubewells and shallow tubewells, and investigates factors associated with POU microbial contamination among deep tubewell users. We assessed a prospective longitudinal cohort of 500 rural households in Matlab, Bangladesh, across 135 villages. Concentration of Escherichia coli (E. coli) in water samples at source and POU using Compartment Bag Tests (CBTs) was measured across rainy and dry seasons. We employed linear mixed-effect regression models to measure the effect of different factors on log E. coli concentrations among deep tubewell users. CBT results show that log E. coli concentrations are similar at source and at POU during the first dry and rainy season, but are significantly higher at POU among deep tubewell users during the second dry season. Log E. coli at POU among deep tubewell users is positively associated with both presence (exponentiated beta exp(b) = 2.52, 95% Confidence Interval (CI) = 1.70, 3.73) and concentration of E. coli (exp(b) = 1.36, 95% CI = 1.19, 1.54) at source, and walking time to the tubewell source (exp(b) = 1.39, 95% CI = 1.15, 1.69). Drinking-water during the second dry season is associated with reduced log E. coli (exp(b) = 0.33, 95% CI = 0.23, 0.57) compared to the rainy season. These results suggest that while households that use deep tubewells have lower arsenic exposure, they may be at higher risk of consuming microbially contaminated water compared to households that use shallow tubewells.